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--- propranolol_for_hemangioma_protocol [2020/06/04 21:54] – created Scott Larson
+++ propranolol_for_hemangioma_protocol [2025/04/18 20:40] (current) – external edit 127.0.0.1
@@ Line 1: / Line 1: @@
-====== Propranolol for Hemangioma Protocol ======
+====== Propranolol for Hemangioma: Outpatient Protocol ======
+==== Dosing ====
+  * 1 mg/kg/d divided BID for 1 week (0.5mg/kg/dose)
+  * 1.5 mg/kg/d divided BID for 1 week (0.75 mg/kg/dose)
+  * 2 mg/kg/d divided BID keep at this dose (1 mg/kg/dose)
+=== Other Considerations ===
+  * Try for 6 hours between doses
+  * Hold if child can't take PO
+  * Child should not skip meals
+  * Typically use for minimum 6 months, 12 months have less recurrences
+  * When lesion treated, tapering is common to ensure no recurrence of the lesion
+  * Monitor Blood pressure and pulse 1 and 2 hours after any dose increase of >0.5 mg/kg/day
+==== Protocol Details ===
+  - Baseline BP and HR
+  - Propranolol 0.5 mg/kg (1 mg/kg/day) PO BID
+  - Check BP and HR 1 and 2 hours after first dose
+  - IF not tolerated:  gradually increase to 0.5 mg/kg PO
+  - IF tolerated: Ensure minimum of 6 hours between doses, warning signs, feed regularly and hold dose if PO intake compromised,  Discharge to home
+  - In 3-7 days: Increase dose to 0.75 mg/kg PO BID (1.5 mg/kg/day)
+  - Check BP and HR 1 and 2 hours after new dose
+  - If not tolerated:  Keep at 1 mg/kg/day and assess efficacy
+  - If tolerated: discharge home
+  - In 3-7 days Increase dose to 1 mg/kg PO BID (2 mg/kg/day)
+  - Check BP and HR at 1 and 2 hours after new dose
+=== Vital Sign Information ===
+  * Blood Pressure & Pulse screening:  [[infant_vital_signs|Normal Infant Vital Signs]]
+  * Inappropriate Bradycardia
+    * Newborns (<1 month old) <70 BPM
+    * Infants (1-12 months old) <80 BPM
+    * Children (>12 months old) <70 PBM
+  * Inappropriate Systolic Blood Pressure (< 5th percentile for oscillometric or <2 SD below mean for auscultation)
+    * Newborn: <57 mm Hg (oscillometric) or 64 mm Hg (auscultation)
+    * 6 months: < 85 mm Hg (oscillometric) or 65 mm Hg (auscultation)
+    * 1 year: <88 mm Hg (oscillometric) or 66 mm Hg (auscultation)
+=== Treatment Location Considerations ===
+  * Inpatient for <8 weeks old or any age with inadequate social support or co-morbid conditions affecting the cardiovascular or respiratory system
+  * Outpatient for > 8 weeks old with good social support and no co-morbid conditions
+==== Adverse Effects ====
+see drug information for [[propranolol|propranolol]]
+  * Hypoglycemia- child should eat every 4 hours
+  * Hypotension- check blood pressure after dose change
+  * Bradycardia- check pulse after dose change
+  * [[infant_vital_signs|Infant Vital Signs]]
+''Parents to call if...''
+  * Lethargy
+  * Cool Clammy skin
+  * Breathing Difficulties
+{{tag>drugs}}

drugs